U.S. laws a barrier for advance directives: study

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NEW YORK (Reuters Life!) - U.S. laws concerning advanced planning for end-of-life care, including so-called “living wills,” set up too many practical roadblocks for many people to put them into place, a study found.

The study, led by Rebecca Sudore of the University of California, San Francisco, covered laws in all 50 of the states and comes as Congress debates the future of health care reform — debate that has included false rumors about “death panels” that would determine who receives care at the end of life.

Most states, Sudore’s team found, had practical restrictions that could make it difficult for many people to complete an advanced directive, which is a legal document that allows people to state their wishes for end-of-life care in the event they become too ill to make their own medical decisions.

In addition, many of the documents used in end-of-life planning were written in complicated legal language that the average person would have trouble understanding.

“Unintended negative consequences of advance directive legal restrictions may prevent all patients, and particularly vulnerable patients, from making and communicating their end-of-life wishes and having them honored,” Sudore and her team wrote in the Annals of Internal Medicine.

One of the best known examples of advance directives are “living wills,” which spell out what types of life-prolonging measures a person does or does not want, such as being put on a ventilator if you cannot breathe on your own or wanting doctors to attempt resuscitation if your heart stops.

A 2007 Harris poll found that about two in five U.S. citizens have these.

Different U.S. states have different laws on advance directives, but the study found that virtually all are written at a reading level well above high-school level — a problem given that some 40 percent of U.S. residents read at a level no higher than an average 13-year-old.

Other obstacles include the fact that many states do not allow oral advance directives, and usually require that written documents have witnesses’ signatures, be notarized, or both. Both may be too restrictive for people who are socially isolated, such as the elderly, Sudore and her team said.

In addition, 40 states do not automatically allow domestic partners and same-sex partners to become the default healthcare proxy, the person who makes medical decisions when patients cannot do it themselves.

End-of-life planning has been in the news as recently as last month, when the administration of U.S. President Barack Obama announced a new regulation that would give doctors reimbursement for counseling patients on end-of-life planning as part of their regular check-ups.

Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia, agreed with the recommendations for legal changes, but said this was far from the greatest problem.

“The biggest issue is that people do not want to do advance directives,” he told Reuters Health.